Lokman: GFN 2020 Centered on Harm Reduction

Regulation of e-cigarettes and other smoke-free nicotine products became a major topic during the virtual Global Nicotine Forum 2020 (GFN 2020) this year as advocates seek a more promising solution for smokers to quit.

The forum, themed “Nicotine: Science, Ethics and Human Rights,” was held on June 11-12, saw 30 experts across the globe speak, all with one common goal; to provide a safe and transparent industry for both smokers and those planning to make the switch to alternative tobacco products.

Discussions started with how attacks on the THR (tobacco harm reduction) movement has been intensified with fake news, misleading studies and unethical media campaigns. All speakers agreed that action needed to be taken immediately before things worsen and that the technology needed to be regulated, not restricted or banned.

Adult consumers should have access to their choice of regulated devices and liquid as it can substantially reduce the risks suffered by smokers from the tar, which is the byproduct of smoke. The THR advocates also highlighted that consumers needed to be truthfully and wholly informed of the life-saving potential of vaping.

Anaesthesiologist Dr John Oyston spoke on the importance of a patient-centred approach where he spoke of patients who needed removal of their lungs or amputation of the leg due to their smoking habit.

He said that if these patients did not smoke or had stopped smoking at middle age, such procedures were unnecessary.

“I’ve seen the damage cigarettes do to the human body or to the human lives. I believe tobacco is the real pandemic,” he said.

“Even in this plagued year, tobacco is on track to kill five times as many people as Covid-19. E-cigarettes are far many times safer than combustible cigarettes and it makes no sense for us to allow people to continue smoking cigarettes.

“Banning e-cigarettes is an infringement to people’s right to choose a safer alternative and to make their own healthcare decisions.”

Oyston, who has nearly 40 years of medical practice under his belt, said e-cigarettes could save about six million lives in the United States and yet some people are trying to ban it and prevent them from being utilised.

“The global tobacco industry makes US$62 billion (RM264.1 billion) in profit and at the cost of 7 million deaths every year. They accept the death of half of their customers as sacrifice they have to pay in order to make money,” he said.

Conference director Professor Gerry Stinson said nicotine was among the top three most favourite drugs globally and calling the traditional cigarette “a dirty nicotine delivery system,” highlighting that it was the combustion that causes the problem.

Stinson, who is from Imperial College London and formerly part of the London School of Hygiene and Tropical Medicine, stated that if the nicotine was separated from the cigarette itself, such as what vaping, snus and Heat-Not-Burn products, it gave smokers potential to switch away from smoking.

Dubbing these new technologies as a “free gift to public health,” Stinson, however, admitted that many smokers globally continued to be misled by major campaigns against THR.

Meanwhile, Professor David Sweanor echoed the same idea, saying that these new nicotine products had the potential for the biggest breakthrough in public health. He said advocates, experts and stakeholders needed to use the principles of reason, science and humanism to look at what is available and work out what could be done.

Stinson and Sweanor both touched on the role of taxation, stating that consumers would likely switch to vaping if it was cheaper and more accessible compared to the cigarette.

“Safer nicotine products have to be cheaper but there’s more we can do to make them accessible. No doubt countries will be concerned about the loss of tax revenue — but please think of this and how important it is.

“The opportunity we have is to fundamentally change the course of public health history, relegating cigarettes to history’s ashtray,” Sweanor said.

He also reiterated that separating nicotine from cigarette was safer and less harmful to body as it removed the deathly ingredient; tar. He quoted Michael Russel, “People smoke for the nicotine but die from the tar.”

The forum also agreed that regulation for the nicotine products was vital to avoid a repeat of the national outbreak of e-cigarette, or vaping, product use-associated lung injury (Evali) crisis that took over the United States last year.

Director of Pro-Vapeo Mexico Dr Roberto A Sussman said the certain parties had taken advantage of the Evali crisis to spread misinformation and fear on vaping which did not only affected the States but globally as well.

“This was seen in many polls. For example, 66 per cent of Americans thought incorrectly that Evali was caused by Juul (an e-cigarette brand) and other vaping devices.

“Unfortunately, only 28 per cent thought correctly that this surge of disease was caused by the illegal THC vape pens,” the physics lecturer at National University of Mexico said.

The United States Centers for Disease Control and Prevention, after completing investigations in February, recommended that people not use THC-containing e-cigarette or vaping products since it has identified vitamin E acetate, often used as an additive in THC-containing products, as a chemical of concern.

More than 30 countries worldwide have banned e-cigarettes as of 2020 including Thailand, Singapore, Brunei and Indonesia. As of April last year (2019), Malaysia’s former Health Minister Datuk Seri Dr Dzulkefly Ahmad announced a new bill whilst pointing out that at present tobacco cigarettes and e-cigarettes are regulated under different directives.

Cigarettes are regulated by the Control of Tobacco Product Regulations 2004 under the Food Act 1983, while e-cigarette liquid containing nicotine, falls under the Poisons Act 1952. He stated that the new bill will underline all regulations and controls on e-cigarettes and vapes, including the sales guidelines.

However, there has been no news or updates following the change in government back in March and Covid-19 pandemic.